Impact of change of ischemic burden on the outcomes of ESRD patients awaiting kidney transplantation.

Background: In asymptomatic patients with end-stage renal disease (ESRD) wait-listed for kidney transplantation (KT), it is unclear whether a change in ischemic burden on serial surveillance SPECT myocardial perfusion imaging (MPI) impacts outcome.
Methods and Results: In a retrospective cohort of 700 asymptomatic KT candidates with ≥ 2 sequential SPECT-MPI studies, we defined a significant change in ischemic burden between MPIs as ΔSDS of ≥ 2 points. Patients were followed for mean 19 ± 12 months after MPI ₂ for cardiac death or myocardial infarction. Between MPIs, 29 (4%) subjects received coronary revascularization which was associated with a greater incidence of reduction in ischemic burden on MPI ₂ (31% vs. 17%, P = 0.049). Among 514 patients with no ischemia on MPI ₁ (SDS ≤ 1), 15% had new ischemia on MPI ₂ which was associated with increased MACE (adjusted HR 1.75; CI 1.02-3.01; P = 0.041). Among 186 patients with ischemia on MPI ₁ (SDS ≥ 2), 66% had improvement of ischemic burden on MPI ₂ which was associated with significantly lower MACE (adjusted HR 0.46; CI 0.25-0.82; P = 0.009). There was no significant interaction between coronary revascularization and improvement in ischemic burden impacting outcome (interaction P = 0.845).
Conclusion: Among KT candidates who underwent serial MPI for CAD surveillance, new ischemia was associated with increased MACE risk. Improvement in ischemic burden was associated with lower MACE risk irrespective of coronary revascularization status.
(© 2023. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.)